Fact Check: Trump claims coronavirus tests are widely available. They are not

Michael CollinsNicholas WuCara KellyDavid HeathUSA TODAY

Wednesday

Apr 22, 2020 at 9:21 AM

WASHINGTON – President Donald Trump says there are plenty of coronavirus tests available, while many governors raise alarms, saying they continue to run short even as states begin to lift their stay-at-home orders.

"This is probably the number one problem in America, and has been from the beginning of this crisis, the lack of testing," Maryland Gov. Larry Hogan, a Republican and the chairman of the National Governors Association, said on CNN Sunday.

Trump fired back Monday, insisting that there was “tremendous capacity” for coronavirus testing at U.S. labs. He said governors like Hogan just needed “to get a little knowledge” about the testing situation.

In fact, the country’s largest private labs say they have plenty of capacity to test samples sent from medical offices and hospitals. But governors in a wide array of states say healthcare providers can’t conduct the tests because of a lack of supplies such as swabs and a chemical known as a “reagent” crucial to the process.

Public health experts and private and public labs contacted by USA TODAY agreed that a major problem was a shortage of supplies at the testing sites where mucus samples are taken.

Wyoming Gov. Mark Gordon, a Republican, said states have been competing with each other to try to get more testing supplies, a process he described as “a slog.”

Concerns over testing have escalated as the Trump administration has issued guidelines meant to help states ease the temporary social distancing restrictions put in place to slow spread of the coronavirus and reopen their economies.

The guidelines call for a three-phase approach: testing, tracing contacts of those infected, and, in time, treatment solutions.

“It’s a perilous set of circumstances trying to figure out how to make this work,” Gordon said last week, “and until we’ve got the testing up to speed – which has got to be part of the federal government stepping in and helping – we’re just not going to be there.”

Swab shortages

At a recent briefing, Trump discussed the swab issue, holding one up alongside a Q-Tip he pulled from his jacket pocket. Trump dismissed swabs and reagents as “so easy to get,” arguing that it was far harder to ramp up production of ventilators.

But in a tacit acknowledgement of the urgency of producing more swabs, he announced that he would be activating wartime powers under the Defense Production Act to compel companies to ramp up manufacturing of them.

“We also are going to be using, and we’re preparing to use, the Defense Production Act to increase swab production in one U.S. facility by over 20 million additional swabs per month,” Trump said.

Like other aspects of testing, the shortages are not consistent across the country. Thomas Denny, chief operating officer of the Duke Human Vaccine Institute and a former consultant to the Centers for Disease Control and Prevention, said his lab has no problems getting the supplies.

Ashish Jha, the director of the Harvard Global Health Initiative, blames the federal government for failing to address that unevenness.

"Everybody has different sets of problems, and the solution is greater coordination," he said. "So if one state has too many swabs, but not enough reagents, and the other state doesn't have enough swabs but plenty of reagents, you can imagine swapping."

Instead, Jha said, states got into "bidding wars” for materials, like those that erupted around ventilators and protective equipment.

"What's happening is some states that are missing swabs, they're trying to call swab manufacturers,” he said. “And then those manufacturers are getting calls from 20 different states.”

Hospitals go it alone

From the beginning, America's stumbling rollout of testing significantly slowed the nation's response.

Flawed tests were shipped in February to state and county public health labs nationwide. The nation’s vast network of hospital and private commercial labs did not get the Food and Drug Administration’s regulatory green light until the end of February.

Dr. Dan Hanfling, who advised the National Healthcare Preparedness Program in the Obama and Trump administrations, noted there were "technical challenges" to developing accurate tests so quickly for a new virus.

One challenge, Hanfling said, is that testing was rolled out without an "ironclad guarantee that these tests are reliable" – a formula for setting expectations too high.

"People expect a certain level of testing, and we're just not technologically there yet," he said.

By the end of March into April, testing accelerated, with the majority processed by six large commercial lab companies: ARUP, BioReference Laboratories, LabCorp, Mayo Clinic, Quest Diagnostics and Sonic Healthcare.

Soon, those labs faced growing backlogs. On March 25, Quest Diagnostics had 160,000 test orders waiting to be processed, according to documents obtained by CNN.

In frustration, hospitals and state public health labs started going it alone, developing their own tests and processes.

Robert Hart, executive vice president and chief medical officer of Ochsner Health in Louisiana, said his state lab was the only place conducting testing. They were getting the results back within a few days.

Then the state was overrun.

“The next move was to send them to the Mayo Clinic,” Hart said. “Mayo quickly became overrun.”

Tests waiting to be completed were shuffled around to the University of Washington and then to Quest, which hit the backlog.

Hart said Oschner started doing testing in its own laboratory and now has results within a day.

Today, the private labs say things have changed. They have room to spare and are turning results around quickly.

“Our current capacity is greater than the volume we are currently receiving, and we have no backlog,” said Mike Geller, spokesperson for LabCorp. “Based on current testing volumes, we are now able to deliver test results on average between one to two days from the date of specimen pick up.”

Louise Serio, a spokesperson for the American Clinical Laboratory Association, said the group’s members, which include Quest and LabCorp, have been reaching out to hospitals and other health care providers to communicate the excess capacity.

She says their member labs have enough testing supplies to meet demand right now, but if they are hit with double or triple the demand for testing, Serio says that could be an issue for them as well.

“What we’re focused on for expanding our capacity,” Serio said, “is making sure we have all of the supplies necessary and predictable access to those supplies.”

Shipment from South Korea

The dispute between Trump and the states over testing came to a head this week when Hogan, the Maryland governor, announced he had secured 500,000 coronavirus tests from South Korea.

Later that day, Trump held up a list at his daily briefing of what he said were 5,000 labs nationwide that are prepared to accept the tests. Asked by USA TODAY Tuesday for a copy of the list, the White House declined to provide it.

Hogan tweeted that he was "grateful" to Trump for the list of labs

Both Democratic and Republican governors have been urging the Trump administration to do more to help increase the availability of testing supplies.

“We have a worldwide shortage of some of the materials that go into this. We really need help,” Ohio Gov. Mike DeWine, a Republican, told “Meet the Press” on Sunday. “I could probably double – maybe even triple – testing in Ohio virtually overnight if the FDA would prioritize companies that are putting a slightly different formula together for the extraction reagent kit.”

Michigan Gov. Gretchen Whitmer, a Democrat, also said her state could handle two or three times the amount of testing, but lacks the swabs and reagents needed to process the tests.

“We could, if we had all the supplies we needed, do 11,300 tests a day working with our current capacity,” she said Monday. “The reality is that we’re about half of that.“

In a phone call between Vice President Mike Pence and governors on Monday, Whitmer said the plea for the federal administration to use the Defense Production Act to compel production of the supplies was loud and clear.

“We talked quite a bit about the lack of the critical supplies for testing,” she said, adding that testing needs to be much broader for states to feel confident in lifting their stay-at-home orders.